| NPI | 1033638762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020021862) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161949) |
| 101YP2500X Counselor, Professional (Licence: OH E.1800740-SUPV) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2024-05-28 |